posterior tibial tendonitis - experiences?

Mine was terrible. I don't have insurance and didn't go to the doctor. I tool a couple days off then just ran through it. I didn't run every day again at first but eventually I did. Didn't really lose any fitness. It hurt all the time and was sore to the touch. The tenderness stuck around for months.

I had it for stints of 3 months, and 6 months, within a years time. Worst injury of my career. One of the reasons being the length, but it is one of those injuries that only rears its ugly head after some running activity.

I would test it every 2 weeks, and every single time about 15 minutes into my run, the pain would appear.

Usually within a week the intial pain would subside. I could walk fine, sprint, so on, just could not make it past 15 minutes of sustained running. I did loads of hip/glute work, and calf/lower leg strengthening. Also began to incorporate yoga. I switched back to an old pair of stability shoes and found it to be more comfortable over time. I bought a new pair and it's been 4 months since.

Go to see a Graston provider. The Graston Technique can stimulate fibroblast formation over damaged tendons and ligaments to significantly increase the rate of healing, and also helps remodel old scar tissue to create funcitonal scarring. Its highly effective for Posterior Tendonitis/tendonopathy.

I've had it on and off for approaching ten yrs. It got to the point where I gave up on physios and went to a sports doctor. I'm due for a yearly check up in Jan 2013.

In my case it was caused by doing all my running off road, on a very uneven surface. The worst time being when the ground was hard, causing the foot to twist into all manner of angles, thus creating a lot of work for the Tib Post.

My tips: the treadmill can help when you re-hab - it's perfectly flat...

Get a wobble board - paramount. Use it. For at least 5-10 mins a day. Work on both legs equally.

Equally paramount: make sure you run with high cadence. At least 185. Elites tend to be over 190. Practise lots of drills to improve form. Pose 'change of support' etc. High knees. Run like a gazelle, on hot coals.

A combination of high cadence and strengthening should really make a difference. Low cadence is a classic culprit for TP issues.

BTW - this is one injury you really cannot 'run through'. If it's end of season and you've trained your butt off for a big race, by all means. But then you need to rest for a substantial period. Use the elliptical to keep the aerobic system in order (elites use them).

If you have the *slightest* twinge from the PT, it isn't ready. It's not like the achilles. Unfortunately, it will only heal with a total cessation of impact-creating activity and a rehab of strength work.

Be weary of NSAIDs... Research suggests they weaken tendons over time.

BTW - Stability shoes will likely make it much worse. They attain much of their supposed 'stability' by being tight around the ankle - constricting blood flow to the PT. Get lightweight, neutral shoes (something like a Kinvara) and run with high cadence.

It took me around 8 weeks to get over my tendinitis this winter. I rushed back into things too quickly and got injured, but for the most part I am back to my previous level.

GOOD LUCK! getting injured sucks.

WD40 wrote:

BTW - Stability shoes will likely make it much worse. They attain much of their supposed 'stability' by being tight around the ankle - constricting blood flow to the PT. Get lightweight, neutral shoes (something like a Kinvara) and run with high cadence.

I was wearing a pair of lightweight neutral shoes when I got injured again the 2nd time around. I only went back to the stability shoes because I had a nice healthy streak in them in the past. Of course what works for me might not work for everyone else. I was also pretty much rested at the point I started to train in them again. It had been the 6th month of rest, and I didn't feel any sort of ache or pain. I'm healthier and running more now then I was prior to the injuries.

During your stunts of 3/6 months, was that with no running at all? I'm @ 11 weeks, still stiff/sore and achy in the morning and hurts significantly if I put a lot of weight on it (think single leg squat). Walking is okay. I feel like it is never going to heal

Any other posterior tibial sufferers willing to chime in?

You're not talking about simple tendinitis anymore, since it's progressed to a partial tear. It's been 11 weeks, 8 of which involved immobilization, and it doesn't sound like you've seen any improvement. Tendons don't get much bloodflow and are pretty tough to heal on their own once they're torn. Sometimes you can get lucky if you catch it early enough and immobilize it right away, but with the timeframe you're talking about, I'd say it's not going to heal. Especially with posterior tibialis, since not only is it instrumental in running, but you use it every time you walk or stand, so it's nearly impossible to rest it completely. If you have the money to blow, you can try PRP, but it's expensive and doesn't have that great of a track record for working for this particular injury. It's probably time to look into surgery. Most likely you want a tendon repair and FDL transfer. Some surgeons might also recommend a calcaneal osteotomy, but if you've been running a long time and this is the first time you've ever had this injury, I would try to avoid something that would completely change your biomechanics. It's not a very common surgery, and a lot of the people who undergo this surgery are overweight people who are just looking to walk painfree again, so you'll want to take your time looking around for a really good surgeon who has done this surgery thousands of times before. I struggled with this injury for a year and tried every conservative treatment I could afford before finally giving in and having surgery last August. I'm back to running 90 mpw and doing speedwork, and though my speed isn't there yet, it's (slowly) coming back. If you have any more questions, leave an email address and I'll get in contact with you (sorry, not leaving my email address on LetsRun).

A vexing injury. Been there. Vexing because you can run with it a while. Tends to feel ok while running after warming up and taking advil but will never go away if you don't rest it.

that said, it is often from excessive subluxation of the posterior tibial tendon. I had to have surgery (retinaculum repair) to fix the problem. 3 weeks in cast, 3 in boot. Ran a half marathon 3 mo post op (would recommend that but I did it and it went well)

When I got mine I took a couple of days off, but during that time I did heat/ice therapy 2-3 times a day, did calf raises, rolled my ankles, stretched, and was back running. I also invested in the superfeet insoles and haven't had a problem since. But like another poster said, you don't have tendonitis, you have a tear, so I can't really relate to what you're going through.

Healing so slow wrote:

During your stunts of 3/6 months, was that with no running at all? I'm @ 11 weeks, still stiff/sore and achy in the morning and hurts significantly if I put a lot of weight on it (think single leg squat). Walking is okay. I feel like it is never going to heal

Usually once every 2 to 3 weeks. I had no pain walking on it prior to the runs. My intention was to go for a 3 mile run, but almost every time, around 10-15 minutes into the run, it would flair up again. It would hurt for 2 or 3 days afterwards, then back to normal.

After the first 3 or 4 weeks, the pain and stiffness was pretty much gone, and would only reappear during those test runs or after pretty rigorous leg work.

It felt pretty hopeless during the 6 month ordeal. It is really hard to determine if there has been any improvement or healing. Both times I returned, it seemed pretty random.

I had PTT last year, awful. The day I strained the PTT it felt like someone stabed a knife just below my ankle. Couldn't run another step. In fact, I couldn't run a step for 10 weeks. The biggest problem was getting the inflammation down so it could heal. I went on crutches for 2 weeks to get all weight bearing off it (stupidly it took me 3 weeks to do this) - walking hurt. So the first thing was to ice it like crazy and take a quick course of anti-inflammatories (something like celebrex). I also used an anti-inflammatory cream called Traumeel on the skin over the PTT at the ankle from about week 6 until maybe 20 weeks post injury (once started running I'd put it on after every run). While getting the inflammation down, then next key to recovery was massage.

The biggest thing I did to help was lots of massage, ART, and Graston. You've got to get the post. tib. muscle and the muscles around that area to relax. That and the Graston plus massage on the actual tendon help it heal. Find someone certified in ART/Graston.

10 weeks post injury (while still getting the massage) I was able to go out and walk/jog (4 x 2min walk/2min jog). I carefully built up mileage over about 2.5 months to original volume. Recovered really well and 5 months later started racing and setting PRs*.

also: Strongly recommend at least a good 2-3 months of above massage before even thinking about surgery.

*during my 10 week down time I did do some cross training, so I was able to keep from losing all fitness. I found that I could swim with a pull-buoy between the legs (upper body work only - but hey, it's still cardio), and strangely enough I was able to tolerate the indoor rowing machine (got to use proper form though - I knew a former elite who could show me how). Things I couldn't do: swimming using legs (resistance of water on foot pulled PTT), water "running" (same problem as swimming, but worse), biking (pressure on pedal put stain on PTT), or the eliptical.

Note, I did not do any stength exercises for the tendon until I started up the walk/running. Up until then it really was about keeping inflammation down and massage to get the thing to heal. There was so much inflammation at first that it would have been counter productive.

Since then I make sure to get regular massage and also do pre-hab (wobble board, calf raises, drills in grass, whatever I can think of/tolerate).

FYI: I was wearing the Kinvara when the tendon gave in. Many different things led up to the injury, but I think the final blow was that the Kinvara (1st version) was really soft, very high off the ground, and thus unstable. Last may not have been a perfect fit for me either. I still run in nuetral shoes and racing flats, but I do best if they have a lower profile to the ground. So if you want to go minimal, something like the NB minimus or a good old racing flat is a lot better option than the Kinvara...

That's a ton of stuff, but if it can help, good luck.

Get the hell out of the boot now ! Get a physio to work that tendon now and break up the scar tissue , it will hurt like hell , but you will be surprised how much better you feel.

Add x-training to the come back time , dont just run. Do not rush it.

Shoes can help or hurt talk with your local store , dont think orthotics are a cure , get the foot/ankle strong first.

I am currently experiencing PTT for the second time. I am fairly certain that I set it off this time by playing soccer without my arch supports. If you overpronate you will likely get PTT eventually if you don't support the arch.

I am a skeptical on remedies for PTT. Basically if you injure the PT tendon, the only way to heal it is via rest, and gradual strengthening exercises (heal raises, wobble board) . You are looking at 4 to 8 months of rest.. non-strenuous cycling is ok.. but no running.

People have different opinions, but I did not find any of the following effective: NSAIDs (oral or gel), ultrasound, electric stimulation, or any kind of bandages or kiniseo tape. Just rest and strengthening, and time.

After the first time I had PTT and rested it for 4 months, I was able to go back to running, and had a great year.. however I think once you have had PTT you are forever prone to a recurrence and you have to continue strengthening exercises and you have to watch your form and your mileage. And never go without your arch supports.

I hope that helps someone. I know the first time I had it I had no clue at first what it was.. and at one point wasn't sure I would ever run again. It still Sufis the second time but at least I know now that it will eventually heal. Not sure if Ill ever be able to do a full marathon but halves should continue to be doable...

Good luck!

I am currently experiencing PTT for the second time. I am fairly certain that I set it off this time by playing soccer without my arch supports. If you overpronate you will likely get PTT eventually if you don't support the arch.

I am a skeptical on remedies for PTT. Basically if you injure the PT tendon, the only way to heal it is via rest, and gradual strengthening exercises (heal raises, wobble board) . You are looking at 4 to 8 months of rest.. non-strenuous cycling is ok.. but no running.

People have different opinions, but I did not find any of the following effective: NSAIDs (oral or gel), ultrasound, electric stimulation, or any kind of bandages or kiniseo tape. Just rest and strengthening, and time.

After the first time I had PTT and rested it for 4 months, I was able to go back to running, and had a great year.. however I think once you have had PTT you are forever prone to a recurrence and you have to continue strengthening exercises and you have to watch your form and your mileage. And never go without your arch supports.

I hope that helps someone. I know the first time I had it I had no clue at first what it was.. and at one point wasn't sure I would ever run again. It still Sufis the second time but at least I know now that it will eventually heal. Not sure if Ill ever be able to do a full marathon but halves should continue to be doable...

Good luck!

I had PTT my senior year of cross country and track. It flared up after one race, so i took the next day off. then out of nowhere after our sectional meet, i was in so much pain i could barely walk for the next two weeks. came back to track a little too early, and it still bothered me. got some insoles, didn't do any fast stuff for a month or so, came back strong. ptt free for half a year. i owe it all to the custom insoles.